Negative World Assumptions Mediate the Impact of Early Adversity and External Stressors on Mental Health in Young People Amid Social Unrest and COVID-19

Abstract

The increasing number of population-level stressors globally has raised concerns over their mental health consequences on young people. Few studies, however, have examined such factors in population-based youth samples, particularly with consideration of how different stressor types could affect mental health via their impacts on specific world assumptions. As part of a household-based epidemiological study, 766 young people (aged 15–25 years) participated in this study from June 2021 to 2022. We examined how negative world assumptions, assessed using the World Assumption Scale (WAS), and the subdomains of benevolence, meaningfulness, and self-worth, would mediate the impact of stressors on symptom expression. Stressors included population-level stressful events, such as those related to social unrest (TEs) and the COVID-19 pandemic (PEs), as well as personal stressful life events (SLEs) and adverse childhood experiences (ACEs). Meanwhile, symptoms included depressive, anxiety, and post-traumatic stress disorder (PTSD) symptoms. Results showed that negative meaningfulness assumptions significantly mediated the effect of social unrest–related TEs on PTSD symptoms, while benevolence and self-worth mediated the effect of ACEs on depressive and anxiety symptoms. COVID-19 PEs and SLEs showed no significant association with world assumptions. Higher overall negative world assumptions were also significantly associated with poorer functioning and health-related quality of life. The findings suggest that world assumptions play specific mediating roles between different types of external stressors and symptom outcomes, with population-level human-induced stressors and childhood adversity playing more determining roles. These observations provide opportunities for designing interventions targeting negative world assumptions.

Keywords:

• Adverse childhood experiences
• collective stressors
• COVID-19
• youth mental health
• world assumptions

Acknowledgements

The authors would like to thank all young people who participated in the HK-YES and all research assistants involved for their contribution to this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data of this study are not publicly available, although anonymized data may be made available upon reasonable request by contacting the corresponding authors.

Additional information

Funding

The study was funded by Phase I of the Commissioned Study on Mental Health Survey, Food and Health Bureau, HKSAR Government (Reference number: MHS-P1 (Part 2)).

Notes on contributors

Stephanie M. Y. Wong

Stephanie Ming Yin Wong, PhD, is Research Assistant Professor at the Department of Social Work and Social Administration, The University of Hong Kong. She completed her PhD in Psychiatry with a focus on how personal and environmental factors interact to affect mental health health in young people. She has also been exploring predictors of long-term outcomes in depression and psychotic disorders both in at-risk and clinical populations, as well as the design of more accessible and acceptable means of mental health interventions in the community.

Terry T. Y. Lau

Terry Tak Yee Lau, MSc, is currently a clinical psychologist trainee at The Chinese University of Hong Kong. She has been supporting the research work in the area of youth mental health at the Department of Psychiatry, The University of Hong Kong, and will continue to explore topics and intervention work related to mental wellness in palliative care and grief.

Christy L. M. Hui

Christy Lai Ming Hui, PhD, is Associate Professor at the Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong. She is specialised in psychosis studies with particular interests in relapse prevention, medication adherence, cognitive dysfunction, early intervention, and the long-term outcomes of early psychosis. She is also specialised in research in the prevention and early intervention in youth mental health.

Y. N. Suen

Yi Nam Suen, PhD, is Assistant Professor at the School of Nursing, The University of Hong Kong. She is a registered practising nurse and has completed her PhD in Public Health. Her research focuses on promoting physical and mental well-being in community settings, with an emphasis on developing models for social processes in high-risk populations to improve early detection and preventative interventions of mental illnesses.

Sherry K. W. Chan

Sherry Kit Wa Chan, MD, is Clinical Associate Professor at the Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong. Her main research interests are in the evaluation of early intervention services, the longitudinal outcomes of psychosis, treatment-resistant schizophrenia, as well as the psychopathology (particularly insight and delusion) and the neurobiological basis of psychotic-like experiences and psychotic disorders. She is also leading several community and school-based youth mental health programmes aimed at improving the trajectory of mental health outcomes in young people.

Edwin H. M. Lee

Edwin Ho Ming Lee, MBChB, is Clinical Assistant Professor at the Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong. He specialises in the field of psychosis with major interests in psychopharmacology and pharmacoepidemiology, exercise and cognitive interventions, neurocognitive science and neuroimaging, and stigma and social psychiatry. He has also been involved in several youth mental health intervention and research projects in recent years with the aim of reducing mental distress in community-based youths locally.

Eric Y. H. Chen

Eric Yu Hai Chen, MD, is Professor of Psychiatry at Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Senior Consultant at the Institute of Mental Health, Singapore, and Professor Emeritus at the Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong. His work on early intervention in psychosis is well-recognised internationally. In addition, with the aims of further improving access to mental health services and preventing mental disorders in a timely manner, he has been leading the household-based epidemiological study on young mental health in Hong Kong (the HK-YES), as well as several community-based intervention studies targeting at-risk populations, including young people, women, and ethnic minorities.